Evidence-Based Research: The Foundation for Treatment Decisions

Evidence-based medicine (EBM) integrates (1) individual clinical expertise, (2) the best current research evidence that is clinically relevant and patient-oriented, and (3) patient preferences, concerns and expectations, into the decision-making process.

Clinical trials, the source of evidence for EBM, are assigned levels of evidence determined by the type and quality of the study. These levels of evidence (1 to 5, 1 being the best) are then tied to grades of recommendation (a, b, c, d). Level 1a, a randomized controlled trial, has become the gold standard for judging whether there is a clear benefit to the treatment and if it should be recommended for patients with similar conditions.

We are seeing a growing number of physicians who understand how research from clinical trials supports their treatment decisions, thus improving their practices and patient care, said David L. Witsell, MD, MHS, Director of Clinical Trials for the Department of Surgery at Duke University Medical Center and Medical Director for the Research Department of the American Association of Otolaryngology-Head and Neck Surgery Foundation (AAO-HNS/F).

Although evidence-based research is playing an increasingly important role in the day-to-day practice of otolaryngologists-head and neck surgeons across the country, the level of evidence supporting some common intervention options is uneven and the best evidence available is not known in many cases, according to the AAO-HNS/F.

What sets BEST ENT Network apart from other national academies collecting quality data from their members is that our members are actually participating in distinct prospective trials that have the necessary components, such as IRB approval, a defined sample size, an enrollment period, data collection forms and patient questionnaires, and patients who have consented to be studied and are eligible.

-Michael G. Stewart, MD, MPH

BEST ENT Network

As a result, the AAO-HNS/F has created the Building Evidence for Successful Treatments in Otolaryngology (BEST ENT) Network (see sidebar), which is a great way for ENTs to learn about evidence-based intervention by participating in evidence-based research, said Dr. Witsell.

Currently, there are more than 330 volunteer otolaryngologists in this network from community, institutional, and academic practices, added Dr. Witsell. Doing these studies in the community is key since that is where the bulk of medicine and surgery is practiced. Positive results from population and community-based research are much more powerful, because they already encompass the variability of the population and the ENT’s surgical skill and clinical decision making.